ABSTRACT
RESUMO Objetivo Avaliar a presença e extensão dos atributos essenciais e derivados da atenção primária em saúde no programa de controle da hanseníase, sob a ótico médica. Métodos Trata-se de um estudo de avaliação de programas de saúde, com foco na hanseníase, tendo como púbico alvo os médicos atuantes nas ações de controle do programa de hanseníase nas unidades de saúde da atenção primária. Foi utilizado um questionário, elaborado e validado em outro estudo, para medir a presença e a extensão dos atributos da atenção primária à saúde no controle da doença. Os dados foram inseridos em um banco de dados e posteriormente receberam uma análise estatística e descritiva. Esse estudo foi aprovado sob o parecer CEP n° 1.128.385. Resultados Na análise dos escores gerais e dos atributos essenciais observou-se que o município do estudo apresentou alta orientação para as ações de controle da han-seníase. Os atributos acesso, orientação comunitária e orientação profissional receberam médias abaixo do ponto de corte, demonstrando fragilidades existentes nos itens que compõe esse atributo. Conclusão Apesar das fragilidades identificadas, o município de estudo apresenta alta orientação para o desenvolvimento das ações de controle da hanseníase, segundo a avaliação dos médicos atuantes na atenção primária.(AU)
ABSTRACT Objective To assess the presence and extent of essential attributes derived from primary health care in a leprosy control program. Materials and Methods This is an assessment of health programs, focused on leprosy and targeted at doctors working on control actions in a leprosy program of primary health care units. A questionnaire developed and validated in another study was used to measure the presence and scope of primary health care attributes in disease control. Data were entered into a database and statistical and descriptive analysis was carried out. This study was approved within the framework of CEP No. 1.128.385. Results Overall scores and essential attributes of leprosy control actions showed a high exposure to leprosy control actions in the studied city. Community's access, orientation and guidance attributes averaged below the cutoff point, demonstrating the existing weaknesses in the items that make up these attributes. Conclusion Despite the weaknesses identified, the study showed high orientation towards the development of leprosy control actions, according to the assessment made by doctors working in primary care.(AU)
RESUMEN Objetivo Evaluar la presencia y alcance de los atributos esenciales derivados de la atención primaria de la salud en el programa de control de la lepra, desde la óptica médica. Métodos Se trata de una evaluación de los programas de salud, centrados en la lepra, teniendo como público objetivo los médicos que trabajan en las acciones de control de la lepra en el programa de las unidades de salud de atención primaria. Se utilizó un cuestionario desarrollado y validado en otro estudio, para medir la presencia y alcance de los atributos de la atención primaria de salud en el control de la enfermedad. Los datos se introdujeron en una base de datos y más tarde se realizó el análisis estadístico y descriptivo. Este estudio fue aprobado en el marco del CEP N°. 1.128.385. Resultados Las puntuaciones globales y los atributos esenciales de las acciones de control de la lepra tuvieron una puntuación alta, en la ciudad del estudio. Los atributos de acceso, orientación y guía de la comunidad tuvieron un promedio por debajo del punto de corte, lo que demuestra las deficiencias existentes en los elementos que componen estos atributos. Conclusión A pesar de las debilidades identificadas, el estudio mostró una alta orientación en el desarrollo de acciones de control de la lepra, de acuerdo con la evaluación de los médicos que trabajan en atención primaria.(AU)
Subject(s)
Humans , Primary Health Care/methods , Health Programs and Plans/organization & administration , Family Practice/methods , Leprosy/prevention & control , Health Evaluation/methods , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To assess the presence and extent of essential attributes derived from primary health care in a leprosy control program. MATERIALS AND METHODS: This is an assessment of health programs, focused on leprosy and targeted at doctors working on control actions in a leprosy program of primary health care units. A questionnaire developed and validated in another study was used to measure the presence and scope of primary health care attributes in disease control. Data were entered into a database and statistical and descriptive analysis was carried out. This study was approved within the framework of CEP No. 1.128.385. RESULTS: Overall scores and essential attributes of leprosy control actions showed a high exposure to leprosy control actions in the studied city. Community's access, orientation and guidance attributes averaged below the cutoff point, demonstrating the existing weaknesses in the items that make up these attributes. CONCLUSION: Despite the weaknesses identified, the study showed high orientation towards the development of leprosy control actions, according to the assessment made by doctors working in primary care.
Subject(s)
Leprosy/prevention & control , Primary Health Care/standards , Quality of Health Care , Brazil , Family Practice/methods , Family Practice/organization & administration , Family Practice/standards , Health Services Accessibility/standards , Humans , Primary Health Care/methods , Primary Health Care/organization & administration , Surveys and QuestionnairesABSTRACT
BACKGROUND AND AIMS: Chromoblastomycosis is a chronic fungal infection caused by species of the family Dematiaceae. Fonsecaea pedrosoi is the most common etiological agent. The objective of this study was to describe the epidemiological and mycological profile of patients with chromoblastomycosis from the Amazon region of Brazil and to correlate the clinical forms with the histopathological findings and severity criteria. METHODS: Sixty-five patients were submitted to mycological (direct, culture, and microculture) and histopathological (hematoxylin-eosin staining) examination. Severity of the disease was classified according to the criteria proposed by Carrión in 1950. RESULTS: Most patients were males (93.8%) and laborers (89.2%). There was a predominance of verrucous lesions (55.4%), which were mainly found on the lower limbs (81.5%). Two major types of tissue reaction were observed: a granulomatous reaction characterized by the formation of suppurative granulomas rich in fungal cells, which were almost always seen in verrucous lesions, and a reaction characterized by the formation of tuberculoid granulomas with few parasites, which were mainly found in well-delimited erythematous plaque-like and cicatricial lesions (p = 0.0001). A peculiar type of organized mycotic granuloma was observed in 20 subjects. Suppurative granulomas were more frequently detected in severe lesions (p = 0.0189) and in lesions with a duration of >10 years (p = 0.0408). CONCLUSIONS: These results suggest that verrucous lesions present a less competent inflammatory tissue response than patients who develop a well-formed tuberculoid reaction. The latter is associated with a more effective immune response as observed in the limited clinical forms of chromoblastomycosis.
Subject(s)
Chromoblastomycosis , Aged , Ascomycota , Brazil/epidemiology , Chromoblastomycosis/epidemiology , Chromoblastomycosis/microbiology , Chromoblastomycosis/pathology , Female , Granuloma/microbiology , Granuloma/pathology , Humans , Inflammation/microbiology , Inflammation/pathology , Male , Middle AgedABSTRACT
Objetivos: La neuritis crónica (NC) es un grave problema en la lepra y resulta difícil de controlar en pacientes que no responden a la prednisona. En este estudio se evalúa (i) la eficacia de la ciclosporina A (CyA) en el control de pacientes NC y (ii) se analiza la presencia de anticuerpos anti-NGF en el suero de pacientes de lepra y su comportamiento durante el tratamiento con CyA. Método: El esquema del estudio es abierto, prospectivo y no-comparativo. Se estudiaron sesenta y siete pacientes de lepra en tres instituciones diferentes de Pará, Brasil, entre enero 2001 a enero 2004. De entre ellos, 47 no presentaron NC y 20 eran pacientes con NC y en tratamiento con al menos 40 mg/día de prednisona para controlar el dolor y afectación neural. A los pacientes se les administró 12 meses de tratamiento en disminución progresiva, empezando con 5 mg/día. La medición fue la afectación sensorial, mediante examen con el sistema del monofilamento Semmes-Weinstein (SWME), fuerza muscular y dolor espontáneo o relacionado con la palpación. Resultados: Se detectaron anticuerpos frente al NGF en el suero de pacientes de lepra, que posiblemente pueda explicar la depleción de NGF en lepra que contribuye a la neuritis, inflamación y pérdida de nociceptión cutánea. Los niveles humorales de estos anticuerpos en pacientes CN eran algo menores que en los pacientes sin CN. Sin embargo, los niveles anti-NGF en pacientes NC tratados con CyA disminuyeron hasta niveles similares a los de los individuos normales. También experimentaban mejoría la afectación sensitiva, fuerza muscular y dolor. Conclusiones: Estos datos parecen indicar que los anticuerpos anti-NGF están presentes en el suero de pacientes de lepra y pueden influenciar el resultado final de la neuritis y que CyA puede ser útil para controlar la afectación neural y el dolor en los pacientes de lepra
Objetives: Chronic neuritis (CN) is still a major problem in leprosy and is difficult to manage in patients who do not respond well to prednisone. In this study we (i) evaluate the efficacy of cyclosporine A (CyA) in controlling CN patients, and (ii) analyse the presence of anti-NGF antibodies in the sera of leprosy patients, and their behavior during CyA treatment. Design: This was an open, prospective, non-comparative study. Sixty seven leprosy patients in three different institutions in Pará, Brazil were studied form January, 2001 to January, 2004. Of these, 47 had no CN and 20 were leprosy patients suffering from CN and taking at least 40mg/dya prednisone to control nerve impairment and pain. Patients received 12 months reducing course CyA starting at 5 mg/kg per day. The outcome measure was sensory impairment, assessed using Semmes-Weinstein monofilament examination (SWME), muscular force and spontaneous or palpation-related pain. Results: Antibodies against NGF were detected in the sera of leprosy patients, which may explain the depletion of NGF in leprosy contributing to neuritis, inflammation and loss of cutaneous nociception. The levels of these antibodies in CN patients were slightly lower than in patients with no CN. However, anti-NGF titres in CN patients treated with CyA were lowered to levels similar to those in the normal subjects. There was also improvement in sensory impairment, muscular force and pain. Conclusions: These data suggest that anti-NGF antibodies are present in the sera of leprosy patients and may influence the outcome of neuritis, and that CyA might be a useful drug in controlling nerve impairment and pain in leprosy patients
Subject(s)
Humans , Cyclosporine/therapeutic use , Leprosy/complications , Leprosy/therapy , Neuritis/complications , Neuritis/diagnosis , Antibodies/therapeutic use , Prednisone/therapeutic use , Enzyme-Linked Immunosorbent Assay/methods , Prospective Studies , Enzyme-Linked Immunosorbent Assay/instrumentation , Enzyme-Linked Immunosorbent Assay/trends , Pheochromocytoma/diagnosisABSTRACT
Objetivos: La neuritis crónica (NC) es un grave problema en la lepra y resulta difícil de controlar en pacientes que no responden a la prednisona. En este estudio se evalúa (i) la eficacia de la ciclosporina A (CyA) en el control de pacientes NC y (ii) se analiza la presencia de anticuerpos anti-NGF en el suero de pacientes de lepra y su comportamiento durante el tratamiento con CyA. Método: El esquema del estudio es abierto, prospectivo y no-comparativo. Se estudiaron sesenta y siete pacientes de lepra en tres instituciones diferentes de Pará, Brasil, entre enero 2001 a enero 2004. De entre ellos, 47 no presentaron NC y 20 eran pacientes con NC y en tratamiento con al menos 40 mg/día de prednisona para controlar el dolor y afectación neural. A los pacientes se les administró 12 meses de tratamiento en disminución progresiva, empezando con 5 mg/día. La medición fue la afectación sensorial, mediante examen con el sistema del monofilamento Semmes-Weinstein (SWME), fuerza muscular y dolor espontáneo o relacionado con la palpación. Resultados: Se detectaron anticuerpos frente al NGF en el suero de pacientes de lepra, que posiblemente pueda explicar la depleción de NGF en lepra que contribuye a la neuritis, inflamación y pérdida de nociceptión cutánea. Los niveles humorales de estos anticuerpos en pacientes CN eran algo menores que en los pacientes sin CN. Sin embargo, los niveles anti-NGF en pacientes NC tratados con CyA disminuyeron hasta niveles similares a los de los individuos normales. También experimentaban mejoría la afectación sensitiva, fuerza muscular y dolor. Conclusiones: Estos datos parecen indicar que los anticuerpos anti-NGF están presentes en el suero de pacientes de lepra y pueden influenciar el resultado final de la neuritis y que CyA puede ser útil para controlar la afectación neural y el dolor en los pacientes de lepra (AU)
Objetives: Chronic neuritis (CN) is still a major problem in leprosy and is difficult to manage in patients who do not respond well to prednisone. In this study we (i) evaluate the efficacy of cyclosporine A (CyA) in controlling CN patients, and (ii) analyse the presence of anti-NGF antibodies in the sera of leprosy patients, and their behavior during CyA treatment. Design: This was an open, prospective, non-comparative study. Sixty seven leprosy patients in three different institutions in Pará, Brazil were studied form January, 2001 to January, 2004. Of these, 47 had no CN and 20 were leprosy patients suffering from CN and taking at least 40mg/dya prednisone to control nerve impairment and pain. Patients received 12 months reducing course CyA starting at 5 mg/kg per day. The outcome measure was sensory impairment, assessed using Semmes-Weinstein monofilament examination (SWME), muscular force and spontaneous or palpation-related pain. Results: Antibodies against NGF were detected in the sera of leprosy patients, which may explain the depletion of NGF in leprosy contributing to neuritis, inflammation and loss of cutaneous nociception. The levels of these antibodies in CN patients were slightly lower than in patients with no CN. However, anti-NGF titres in CN patients treated with CyA were lowered to levels similar to those in the normal subjects. There was also improvement in sensory impairment, muscular force and pain. Conclusions: These data suggest that anti-NGF antibodies are present in the sera of leprosy patients and may influence the outcome of neuritis, and that CyA might be a useful drug in controlling nerve impairment and pain in leprosy patients (AU)
